tbuckley/cabot-search huggingface dataset:
Abstract P332: Duration of Diabetes and Risk of Multiple Cardiovascular Disease Outcomes
Authors: Shannon C Anderson, Chiadi E Ndumele, Sui Zhang, Olive Tang, Carine Hamo, Erin D Michos, Christie M Ballantyne, Josef Coresh, Elizabeth Selvin, Justin B Echouffo Tcheugui, James Pankow
Journal: Circulation (2023)

Introduction: Diabetes is strongly linked to cardiovascular disease (CVD). However, there is scarce data on the extent of the association of diabetes duration with multiple CVD outcomes (coronary heart disease [CHD], heart failure [HF], and stroke), considered individually and in combination. Hypothesis: A longer duration of diabetes is associated with CVD outcomes or death, independent of age, blood glucose control, and other cardiovascular risk factors. Methods: We included 9,296 participants (mean age 63 years, 58.2% women, 22% Black adults, 19% with diabetes) at ARIC Visit 4 (1996-1998) without CVD at baseline. We calculated diabetes duration at Visit 4 (baseline), utilizing diabetes status at the first four ARIC visits spaced 3 years apart, and self-reported diagnosis date for those with diabetes diagnosed before Visit 1. We used Cox regression to estimate associations of diabetes duration with incident CHD, HF, stroke, a composite of CVD outcomes, and all-cause mortality, adjusted for risk factors. We performed analyses stratified by age (&lt;65 or ≥65 years), race, sex and glycemic control (HbA 1C consistently &lt;7%, vs. HbA 1C ≥7%), with tests for interaction. Results: Over a maximum of 24 years of follow-up, there were 3109 CVD events and 4095 deaths. Compared to adults without diabetes, the risk of each CVD outcome or death rose progressively with longer diabetes duration, except for stroke (Figure). Participants with a diabetes duration ≥ 15 years were at highest risk of CHD (HR: 2.65, 95%CI: 2.00, 3.51), HF (HR 2.65, 95% CI: 2.00, 3.51), composite CVD (HR: 2.47, 95% CI 2.00, 3.05), and death (HR: 1.95, 95% CI: 1.60, 2.37). Except for stroke, the link of diabetes duration with CVD outcomes was stronger among those &lt;65 years, with HbA 1C ≥7%, women, and Black adults (all P interactions &lt;0.05). Conclusions: Longer diabetes duration is associated with multiple CVD outcomes and death. Delaying diabetes onset should be a focus of global CVD prevention, and therapies to improve CVD outcomes might target those with long diabetes duration. Figure: Associations of diabetes duration with cardiovascular outcomes. Legend: HRs were adjusted for age, sex, race-center, smoking, alcohol, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, triglycerides and estimated glomerular filtration rate. Diabetes duration (in years) was modeled as a restricted cubic spline with knots located at 0, 2.6, 7.0, and 19.8 years. Dark shaded area along the curve represents the 95% CI. Bar graph reflects the histogram of distribution. No diabetes served as the reference group. Prediabetes was defined as glycosylated hemoglobin of 5.7% to 6.4%. HF: heart failure, CHD: coronary heart disease, CVD: cardiovascular disease (composite of heart failure, coronary heart disease and stroke)
Abstract P178: Incremental Value of Charlson Comorbidity Index Over Disease-Centric Score in Heart Failure
Authors: Kayode O Kuku, Katie Conners, Joe Shearer, Jungnam Joo, Suzette J Bielinski, Nicholas B Larson, Veronique L Roger
Journal: Circulation (2023)

Introduction: Heart Failure (HF) is a syndrome of high comorbidity and mortality. The impact of comorbidities on life expectancy in HF is well studied, but guideline-recommended disease-centric risk scores such as the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score may not fully account for the effect of comorbidities. The Charlson Comorbidity Index (Charlson) is a validated measure that quantifies the prognostic impact of comorbidities. Objective: To examine the incremental value of Charlson over MAGGIC in predicting death in HF. Methods: In a population-based HF cohort, we computed MAGGIC and Charlson scores using electronically linked medical records. Patients were divided based on ejection fraction (EF) into reduced [EF &lt;50%, HFrEF] or preserved [EF ≥50%, HFpEF]. Cox regression was performed to assess the association between the risk scores and mortality. The incremental value of Charlson over MAGGIC was tested by calculating the area under the ROC [receiver operating characteristic] curves (AUCs) with 95% confidence interval (CI). Results: We studied 1,388 patients with HF validated using the Framingham criteria (mean age, 75±13 years, 48% female, mean EF, 49±17%). The median Charlson was 7.0 (interquartile range 5.0-9.0) and was higher in HFpEF than HFrEF (7.0 [5.0-9.0] vs. 6.0 [4.0-8.3] respectively. Over a median follow-up of 13.9 years (13.3-14.2), mortality was 17.4% (95% CI, 15.4 -19.3%) and 36.8% (95% CI, 34.2-39.3%) at 1, and 3 years respectively. In regression analysis, increasing MAGGIC and Charlson were independently associated with death (HR 1.09, 95% CI 1.08-1.11 and HR,1.22, 95% CI 1.20-1.24, both p &lt;0.001) irrespective of EF. Discrimination ability was improved by adding Charlson over MAGGIC (Table), reaching statistical significance at 3 years. Conclusion: In this HF cohort, the Charlson index provided an added value over MAGGIC in predicting the risk of death at 3 years. These findings emphasize the importance of accounting for comorbidities in mid-term risk stratification in HF.
Abstract P142: Mediation of Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c Through Weight: A Randomized Clinical Trial
Authors: Kirsten S Dorans, Lydia A Bazzano, Lu Qi, Hua He, Chung-shiuan Chen, Katherine T Mills, Bernadette Nguyen, Matthew OBrien, Gabriel I Uwaifo, Jiang He
Journal: Circulation (2023)

Introduction: Low-carbohydrate diets lead to weight loss and improvement in hemoglobin A1c and other cardiometabolic outcomes. However, there is limited research on how much of the glycemic effects of low-carbohydrate diets are mediated by weight loss. Hypothesis: The effect of a low-carbohydrate dietary intervention on hemoglobin A1c would be mediated by weight loss. Methods: We conducted a 6-month randomized clinical trial on the effects of a low-carbohydrate diet intervention (target &lt;40 net grams of carbohydrates during first 3 months; &lt;60 net grams for months 3-6) compared with usual diet on hemoglobin A1c. Participants were 40-70 years with untreated HbA1c of 6.0-6.9%. In post hoc mediation analyses, we examined whether the effect of the intervention on 6-month change in hemoglobin A1c was mediated by 3-month weight, after adjustment for age, sex, race, education, and baseline levels of behavioral and cardiometabolic risk factors. We used the causal framework approach described by and the SAS macro developed by Valeri and VanderWeele. Results: 150 participants (mean [SD] age 59 [8] years; 108 [72%] female; 88 [59%] Black) were randomized to either the low-carbohydrate diet intervention (75 participants) or usual diet (75 participants) arm. Mean (SD) HbA1c was 6.16% (0.30%) at baseline. Six-month data was collected on 142 participants (95%). Compared with the usual diet arm, the low-carbohydrate diet intervention arm had significantly greater 6-month reduction in HbA1c (net difference, -0.23% [95% CI, -0.32 to -0.14%]) and body weight (-5.9 kg [95% CI, -7.4 to -4.4 kg]). In mediation analyses, 59% of the total effect of intervention on 6-month change in hemoglobin A1c was mediated by weight measured at 3 months (Table). Conclusions: In mediation analyses, a substantial proportion (59%) of the total effect of intervention on 6-month change in hemoglobin A1c was mediated through weight measured at 3 months. Future research should further explore contributions of weight loss to reductions in glycemia in other populations.
Abstract P469: Risk of Long-Term All-Cause Mortality After Incident Ischemic Stroke of Different Severity in the Atherosclerosis Risk in Communities Study
Authors: Jinyu Chen, James R Pike, Michelle C Johansen, Priya Palta, Josef Coresh, Rebecca F Gottesman, Silvia Koton
Journal: Circulation (2023)

Background: Stroke is associated with increased risk of mortality. However, studies on the association between stroke severity and mortality using prospective cohort data with details on cardiovascular risk factors at midlife have not been published in recent years in the US. We studied the association between stroke severity and subsequent all-cause mortality in the Atherosclerosis Risk in Communities Study (ARIC) study. Hypothesis: Risk of all-cause mortality increases after incident ischemic strokes with greater risk at higher stroke severity. Methods: Severity of incident ischemic strokes in ARIC from 1987 to 2018 was assessed through review of hospital records using the National Institutes of Health Stroke Scale (NIHSS) and categorized as minor, (NIHSS ≤5), mild (6-10), moderate (11-15), and severe (≥16). Deaths were ascertained through linkage with the National Death Index. We used Cox proportional hazard models adjusted for demographic variables and baseline risk factors to determine the hazard ratios (HRs) for all-cause mortality associated with each category of stroke severity, in participants after incident ischemic stroke compared to those who remained stroke-free throughout the study period. Results: Among 15661 participants free of stroke at baseline (1987-1989), 1036 developed incident ischemic stroke. There were 757 deaths among participants with incident ischemic stroke during the follow-up after stroke (median=16.1 years). Mean baseline age was 54.16 years, 55.2% women and 26.8% black participants. Cox proportional HRs of mortality after incident ischemic stroke controlling for demographics (Model 1) and further adjusted for risk factors at midlife (age 45-64) are displayed in Table 1. Conclusion: Compared to participants free from ischemic stroke, after adjustment for cardiovascular risk factors at midlife, risk of all-cause mortality was 2 to 12-folds higher in ARIC participants after incident ischemic stroke, with a greater risk of mortality observed in those with higher stroke severity.
Abstract P177: Circulating Ketone Bodies and Mortality in Heart Failure: A Community Cohort Study
Authors: Rebecca Oyetoro, Katie Conners, Jungnam Joo, Sarah Turecamo, Maureen Sampson, Anna Wolska, Alan T Remaley, Margery A Connelly, James D Otvos, Nicholas B Larson, Suzette J Bielinski, Joseph J Shearer, Véronique L Roger
Journal: Circulation (2023)

Background: Heart failure (HF) is associated with metabolic alterations, including ketogenesis. However, determinants of ketogenesis and risk of mortality in HF is not defined. Total ketone bodies (KB) include β-hydroxybutyrate, acetoacetate, and acetone and can be measured in plasma by nuclear magnetic resonance (NMR). The aim of this study is to determine the relationship between KB and clinical characteristics in a community HF cohort and to assess the association between KB and all-cause mortality. Methods: A population-based cohort of 1,389 HF patients was prospectively enrolled between 2003 and 2012. Plasma KB was measured by LP4 NMR LipoProfile ® assay/test on the Vantera® NMR analyzer platform. A conditional inference tree method (ctree R Package) was used to determine optimal KB group cut points. Associations between clinical characteristics and KB were measured with Wilcoxon rank sum test and Pearson’s Chi-squared test. Kaplan-Meier method estimated survival. Cox regression analyses were used to estimate associations between KB concentrations and mortality. Results: Among the 1,382 HF patients with KB measurements, the median age was 78 years (IQR 68-84) and 52% were men. Median KB was 180 μM (IQR 134-308). Patients were divided into two groups with lower KB (≤471.5 μM) and higher KB (&gt;471.5 μM). Patients with higher KB (N=210) had lower BMI, higher BNP, and were more likely to be in the New York Heart Association class III-IV; however, these patients were less likely to have hyperlipidemia, coronary disease, or diabetes mellitus (P &lt; 0.05). Age, sex, creatinine, ejection fraction, or Meta-Analysis Global Group in Chronic HF (MAGGIC) score did not differ by KB group. Higher KB was associated with worse survival (figure). After adjustment for the MAGGIC score, higher KB was associated with increased risk of mortality (HR 1.3; 95% CI, 1.08-1.48). Conclusions: In this community HF cohort, higher KB was associated with increased mortality, independent of the MAGGIC score.
Abstract MP69: Day-of-the-Week and Time-of-the-Day Temporal Patterns of Sedentary Behavior Among Hispanic / Latino Adults: Hispanic Community Health Study / Study of Latinos
Authors: Beibo Zhao, Daniela Sotres-Alvarez, Kelly R Evenson, Heather Greenlee, Yasmin Mossavar-Rahmani, Qibin Qi, David Marquez, Tali Elfassy, Denise C Vidot, Elva Arredondo, Keith Diaz
Journal: Circulation (2023)

Objectives: Existing sedentary behavior interventions have largely achieved modest results. Conventionally, interventions have attempted to reduce sedentary time using a full-day approach. An alternative strategy is to target specific periods when sedentary behavior is most prevalent. However, little is known when sedentary time is most likely to occur in adults. This study examined the day-of-the-week and time-of-the-day patterns of sedentary behavior among U.S. Hispanic/Latino adults. Methods: Participants (n=12,241) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-site prospective cohort study of Hispanic/Latino adults, were studied. Sedentary time was measured for one week using a hip-mounted accelerometer. Three sedentary metrics were quantified: total sedentary time, sedentary time in bouts ≥ 60 minutes, and number of sedentary breaks. Results: Temporal patterns across days of the week were statistically significant for all three sedentary metrics (Figure, Panels A-C, p &lt; .001). Total sedentary time decreased from 719±2 mins/d on Mondays to 710±3 mins/d on Fridays the lowest and increased over weekends with Sundays (733±3 mins/d) the highest. Temporal patterns across 3-h periods of the day were statistically significant for all sedentary metrics (Figure, Panels D-F, p &lt; .001). Time-of-the-day patterns had a U-curve pattern wherein adults were most sedentary late at night, became less sedentary throughout the day, reached peak activeness around noon, then became more sedentary into the evening. Day-of-the-week and time-of-the-day patterns were robust across age, employment, work shift, and acculturation subgroups. Conclusions: Mornings, evenings, and weekends were the most sedentary periods in this cohort of Hispanic/Latino adults, characterized by higher volumes of sedentary time, more prolonged sedentary bouts, and fewer sedentary breaks. These time periods should be considered as important windows for behavioral interventions targeting sedentary behavior.
Abstract P182: Post-Discharge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure
Authors: Yulia Khodneva, Suzanne Oparil, Emily B Levitan, Pankaj Arora, CAROLINE PRESLEY, Andrea Cherrington
Journal: Circulation (2023)

Background: Ambulatory follow-up for all patients with heart failure (HF) is recommended within 7-14 days after hospital discharge to improve HF outcomes. This study objective was to examine post-discharge ambulatory follow-up of patients with comorbid diabetes and HF from a low-income population in primary and specialty care. Methods: Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010-2019, were included and the claims analyzed for ambulatory care utilization (any, primary care, cardiology or endocrinology) within 60 days after hospital discharge. Restricted mean survival time regression, adjusted for socio-demographics and clinical factors, examined the time to first ambulatory visit. Multivariable-adjusted Poisson regression estimated prevalence ratios (PR) of primary and specialty care post-discharge visits. Results: Among 9,867 Medicaid-covered adults with diabetes and first hospitalization for HF, [mean age 53.7, SD 9.2 years, 47.4% African American, 10.9% Hispanic/other, 65.4% women], 26.5% had an ambulatory visit within 0-7 days, 15.1% - 8-14 days, 31.0% - 15-60 days and 26.8% - no visit; 71% saw primary care, 12% - cardiology and 1.6% - endocrinology. Compared to Non-Hispanic white adults, African American and Hispanic/other ethnicity adults were less likely to see primary care (adjusted PR 95% Confidence Interval [CI] 0.96 [0.91-1.00], and 0.91 [0.89-0.98], respectively), and their visits occurred later (by 1.8 day, p=0.0006 and by 2.8 days, p=0.0016, respectively). Having 4 or more additional comorbidities was associated with both primary care and cardiology visits (aPR [95% CI] 1.59 [1.35-1.87], and 1.45 [1.01-2.09], respectively). Conclusion: More than a half of Medicaid-covered adults with diabetes and HF in Alabama did not receive post-discharge ambulatory care follow-up as recommended by guidelines. African American and Hispanic/other ethnicity adults were less likely to receive recommended post-discharge ambulatory care for comorbid diabetes and HF.
Abstract P181: Impact of Blood Pressure on Longitudinal Patterns of Pre-Heart Failure in a Hispanic/Latino Population-Based Cohort: Results From the Echocardiographic Study of Latinos (ECHO SOL)
Authors: Priscilla Duran Luciano, Ayana K April-Sanders, Un Jung Lee, Jennifer McLeod, Robert Kaplan, Barry E Hurwitz, Katrina Swett, Martha L Daviglus, Martin Bilsker, Daniela Sotres-Alvarez, Sonia Ponce, Mayank M Kansal, Jianwen Cai, Gregory A Talavera, Carlos J Rodriguez
Journal: Circulation (2023)

Introduction: Hypertension (HTN) is a modifiable risk factor for heart failure (HF) and a common antecedent for pre-HF, but its effect on pre-HF is not well known. Hypothesis: Variations in blood pressure (BP) will be related to distinct patterns of pre-HF (prevalent and incident). Methods: Two echocardiograms were performed ∼4.3 years apart on 1643 adults in the Hispanic/Latino cohort ECHO SOL. Pre-HF was defined as systolic dysfunction (LVEF &lt;50%/ global longitudinal strain &gt;15%) or diastolic dysfunction (≥ Grade 1) or left ventricular remodeling (left ventricular mass index &gt;115 for men, &gt;95 for women/ relative wall thickness &gt;0.42). At visit 1 (V1), 953 were normotensives, and 690 hypertensives [controlled and uncontrolled]. Groups were subdivided at visit 2 (V2) based on maintenance or changes from V1 BP status. Logistic regression models were used to determine the association of BP with pre-HF. All analyses were weighted due to complex survey design. Results: Higher BP at baseline (linear and by tertiles) was significantly associated with prevalent pre HF (table 1). Higher pulse pressure was significantly associated with incident pre-HF (table 1). Normotensives at V1 who later developed HTN (≥ 130/80 mmHg) at V2 had higher odds of having prevalent (2.05 [95% CI, 1.24 - 3.39]) and incident (2.42 [95% CI, 1.07 - 5.51]) pre-HF than those who remained with BP &lt;130/80 mmHg at V2. When defining uncontrolled HTN as BP ≥ 130/80 mmHg, we found that uncontrolled hypertensives at V1 who remained uncontrolled at V2 had higher odds (2.75 [95% CI, 1.18 - 6.41]) of having prevalent pre-HF compared to uncontrolled hypertensives who progressed to controlled HTN at V2 (&lt;130/80 mmHg). Conclusion A significant association exists between BP and prevalent/incident pre-HF in the Hispanic/Latino population. Additionally, those who progress from normal BP to hypertension face an increased risk of developing prevalent/incident pre-HF compared to those who remain normotensives. Blood pressure control of &lt;130/80 mmHg could result in less prevalent pre-HF.
Abstract P165: Key Tenets for Lifestyle Programs Aiming to Improve Hypertension Control and Cardiovascular Health
Authors: Amena Abbas, Julia Jordan, Rachel Davis, Shaquira Robinson, Cagney Morns
Journal: Circulation (2023)

Introduction: Promoting lifestyle changes, such as consuming a healthier diet, engaging in exercise, and quitting smoking can help control hypertension (HTN) and reduce the risk of adverse cardiac outcomes. To support public health practitioners and health care providers, the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) sought to develop a set of key tenets of lifestyle programs that support successful implementation and impact on HTN-related outcomes. Hypothesis: No a priori hypotheses. Methods: We conducted rapid evaluations of three lifestyle programs identified first through a broad call for nominations and then a panel of experts for final selections. We also performed a literature review to assess the landscape of lifestyle programs focused on managing HTN. To build upon these findings, a rigorous mixed-methods evaluation of a local YMCA’s (St. Louis Gateway Region) implementation of a Blood Pressure Self-Monitoring (BPSM) program was conducted to describe program characteristics and innovations and assess HTN outcomes. Results: The evaluation of a local YMCA included 333 participants with HTN (2018-2020) and reported a statistically significant average reduction of 2.6 mmHg in SBP from baseline to 16-week follow-up. Based on comprehensive findings from the project, DHDSP identified the following four key tenets for an effective program: 1) Implementing programs in community settings provides an opportunity to offer programming where people are already gathering and can build trust and commitment. Findings from rapid evaluation of a program held at churches and other community locations demonstrated increased BP control rates from 66.2% to 71.5% at 12-week follow-up. 2) A team-based approach with clinical and non-clinical staff allows for more impactful and effective implementation. Evaluation results demonstrated completion of a program with trained lifestyle coaches was associated with a decrease of 7.3 mmHg in SBP and 5.7 mmHg in DBP over a 16-week period. 3) Programs with shorter durations (between 3-24 weeks) allow for those not able to commit to a longer program to still benefit from learning to control BP and reduce other risk factors. Findings from rapid evaluation of a three-week program resulted in increased BP control from 28.4% to 61.3% by end of program period. 4) Targeting multiple lifestyle behaviors provide the opportunity to closely match participant needs with the type of activities that work best for them. Rapid evaluation of a 12-week program focused on exercise, diet, and reducing stress demonstrated an increase in BP control from 76.9% to 82.2%. Conclusion: Findings can be used as a resource to link patients to effective BP control and management programs that have implemented these key tenets. Strategies highlighted may also provide considerations for replication in other communities.